Two events may cause April 16 to stand out in the memories of health plan providers, but not in a good way. First, Los Angeles City Attorney Rocky Delgadillo's office filed suit against health-plan owner WellPoint and its subsidiaries, alleging that they had unlawfully rescinded patient health-plan coverage and issued deceptive and false advertising. Second, Los Angeles County Medical Association officers and staff met with Delgadillo to discuss how the two organizations could work together to build evidence against healthplan companies engaging in these and other improper practices.

The suit against WellPoint, Anthem Blue Cross of California and Anthem Blue Cross Life stems from company dealings with consumers and company press releases concerning its practices. In the course of a separate investigation of hospitals that dumped homeless patients on the street, the city prosecutors discovered evidence of health-plan company wrongdoing regarding coverage rescission, including misleading application forms, leading to mistakes that can result in rescission, lack of medical underwriting, and untrained contractors with incentives to sign patients up.

In February, the City Attorney's office sued Health Net over these practices. In March it demanded that WellPoint and its subsidiaries back up assertions that they had cleaned up their procedures, and most recently, the office filed suit against the WellPoint companies similar to that against Health Net.

In its partnership with the city office, "LACMA is going to help promote specific examples from its members for prosecution," said association President David Aizuss, MD. "LACMA is also going to educate its member physicians to recognize and report improper practices by insurance companies that lead to the denial of care or payment for services rendered," continued Dr. Aizuss.

LACMA originally offered to help the attorneys after it learned of the prosecutors' March announcement that they had launched www.ProtectingTheInsured.org to gather payer misconduct information, said the association's CEO Dominick Spatafora. In coordination with the office, LACMA then sent a letter urging its members to report any experiences with health plan companies and insurers that might aid the effort.

In an additional effort, LACMA will distribute a high-profile information sheet explaining patient rights, how they can avoid denials of care, and where they can go for help, Spatafora said.

Physician response to the letter has been light so far, said Steven Gold, a deputy city attorney. Doctors are a busy group, but health plan contracts might also be hindering them, he said. "They're pretty scary documents, in terms of the confidentiality obligations that they impose and the unbelievable one-sidedness." But the prosecutors generally agreed that doctors could point investigators in the right direction, such as toward specific billers, even if physicians are reluctant to get involved directly.

In a wide-ranging conversation on future avenues of approach, the four prosecutors and LACMA representatives discussed tackling topics such as restrictive payer definitions of medical necessity, slow pay and no pay, pharmacy formularies altered arbitrarily by healthplan companies, and inaccurate physician rosters maintained by plans. Noting that the city prosecutors had so far based their approach on consumer law, LACMA Treasurer Robert Bitonte, MD, who is also a lawyer, suggested that they also pursue it with the the Calif. Health and Safety Code in mind.

"Facts are a stubborn thing; they can't be changed by passion," Delgadillo said, quoting John Adams. "We know they're out there, it's just collecting them" that is difficult," he said.